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Functionally based exercise program for children with cerebral palsy Print E-mail

Field: Rehabilitation programme
Target group: Patients/clients in rehabilitation with Cerebral Palsy GMFCS level I or II (mostly children)
Purpose:

  • Improve the patients’/clients’ physical activity and physical fitness level.
  • Promote an active lifestyle after rehabilitation.
  • Prepare patients/clients for reintegration into society after rehabilitation.


Programme:
Children with cerebral palsy (CP) have distinctly subnormal aerobic and anaerobic capacity in comparison with typically developing peers. Also, muscle mass is low, muscle strength is reduced and energy cost of locomotion is high. Low levels on these fitness components may contribute to the difficulties in motor activities most children with CP encounter in daily life. Moreover, evidence suggests that hypoactive children are more likely to become physically sedentary adults and that encouraging the development of physical activity habits in children will help us to establish activity patterns that continue into adulthood. A functionally based exercise programme, that had to be easily implemented in clinical practice,was developed. All children, regardless of their age and GMFCS-level (I or II), performed the same exercises during the programme. The children worked in couples during the circuit training-sessions. Weused task-specific exercises such as running and changing the direction of the body abruptly, step-ups and negotiating stairs since they are important in everyday life of children and adolescents with CP. The standardised exercises, aimed to improve daily functioning, were repeated throughout the programme. The training programme lasted for 8 months, and consisted of two training sessions a week. Each session lasted 45 minutes. Each training session started with an introduction of approx. 5 minutes. In these 5 minutes a heart-rate monitor was attached to the child during the first 6 months, because they used it to guide them during the aerobic training sessions. The remaining time was used to provide information and to explain the purpose of the training that was ahead. In the following 5 minutes different activities/ games were used to get the children warmed-up. In the most important training-part we used 8 standardised task-specific aerobic and anaerobic exercises, which were based on walking activities, such as running / walking fast, step up and down, stepping over, bending, turning, and getting up from the floor. The children kept track of their progression using a score-sheet. On this score-sheet they recorded the number of repetitions they achieved. This kept most children motivated throughout the programme.

Since the duration of the exercise increases in the first three months the number of repetitions will increase as well, even if they do not increase their fitness. This provides positive reinforcement for the first training months, which are the hardest. Every 6 weeks a game is played during the training sessions. In this way the children have something to look out for. Some of these games included are obstacle softball (between each base an obstacle was placed), soccer and dodge ball. The target group of people with CP in this programme requires therapeutic competences and knowledge of:

  • Understanding the general recreation and sport adaptation model for patients/clients including their personal profile, the function related implications, the specific activity requirements, and the aim of participation.
  • Understanding and evaluate the interrelation between determinants of human functioning.
  • Understanding the impact and risks of physical activity.
  • Knowing the impact of medication on exercise performance. 69
  • Understanding indications and contra-indications of sports and adapted physical activities in the rehabilitation of specific populations.

A well-run programme for persons with CP requires a pedagogical competences and knowledge in these areas:

  • Understand the sport-specific equipment – user – interfaces.
  • Understand the major components influencing the process of adapting activity situations.

Management competences and knowledge are equally important mainly in:

  • Understanding the various community based physical activity and sports organisations eligible for patients/clients in the Adapted Physical Activity programme.

Example of good practice presented in book Functionally based exerciseprogram for children and adolescents with cerebral palsy by Olaf Verschuren (2009; available for download on www.eufapa.eu) was described by Joeri Verellen.

 

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